From the Guidelines
Hemorrhoids can be effectively treated with non-operative management as first-line therapy, including dietary and lifestyle changes, such as increased fiber and water intake, and adequate bathroom habits, as recommended by the most recent guidelines 1.
Key Recommendations
- Increase fiber intake to 25-30 grams daily through foods or supplements like psyllium (Metamucil) or methylcellulose (Citrucel) to soften stool and reduce straining during bowel movements.
- Drink 6-8 glasses of water daily to help soften stool and prevent constipation.
- Avoid straining during bowel movements and limit time spent on the toilet to reduce pressure on the rectal veins.
- For symptomatic relief, consider administering flavonoids, as suggested by recent guidelines 1, although the evidence is moderate and the recommendation is weak.
Treatment Options
- For immediate relief, try warm sitz baths for 15-20 minutes, 2-3 times daily.
- Over-the-counter options include topical treatments containing hydrocortisone (such as Preparation H or Tucks pads) to reduce inflammation and pain, applied up to four times daily for no more than one week.
- Oral pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) can help manage discomfort.
- For persistent or severe hemorrhoids, prescription-strength creams or procedures like rubber band ligation may be necessary, as indicated by older studies 1.
Important Considerations
- Hemorrhoidectomy, the most effective treatment for hemorrhoids, is associated with significantly more pain and complications than non-operative techniques and should be recommended only for a small minority of patients, as stated in older guidelines 1.
- The choice of individual technique depends in part on the physician’s training, experience, and preference, as well as the patient's specific condition and needs.
From the Research
Hemorrhoid Treatment Options
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment for hemorrhoids 2
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, like sitz baths, can also be effective in managing hemorrhoids 2, 3
- Office-based treatments, including rubber band ligation, are preferred for grades I to III internal hemorrhoids due to their lower failure rate compared to infrared photocoagulation 2
- Surgical options, such as open or closed excisional hemorrhoidectomy, are typically reserved for recurrent or higher-grade disease, as they can result in greater pain and a prolonged recovery 2, 3
Non-Operative Approaches
- Sclerotherapy and rubber band ligation are non-operative approaches that can be used to treat hemorrhoids 3
- Lifestyle modification, fiber supplement, suppository-delivered anti-inflammatory drugs, and administration of venotonic drugs are also used in the conservative treatment of hemorrhoids 3
Surgical Interventions
- Hemorrhoidectomy, stapled hemorrhoidopexy, and hemorrhoidal artery ligation are surgical options available for the treatment of hemorrhoids 2, 3, 4
- These procedures can be effective in reducing symptoms, but may also result in postoperative pain and potential complications, such as anal stricture and incontinence 3, 4
Guidelines and Recommendations
- The French Society of Colo-Proctology recommends that medical treatment, including dietary fiber, should always be proposed as the first line of treatment, with instrumental treatment and surgery reserved for cases where medical treatment fails or is not suitable 5
- The choice of treatment should be individualized based on patient factors, such as the degree of hemorrhoids, patient preference, and convenience 6, 4